Peripheral Arterial Disease Flashcards
what is it due to
atherosclerosis- stenosis of arteries
what is it due to
atherosclerosis- stenosis of arteries
what is the main symptom
intermittent claudication
symptoms
cramping pain- calf, thigh, buttock after walking given distance and relieved by rest, ulceration, gangrene, foot pain at rest eg burning pain at night relieved by hanging legs over side of bed
what is the classification
Fontaine- 1: asymptomatic. 2: intermittent claudication. 3: ischaemic rest pain. 4: ulceration/gangrene (critical ischaemia)
signs
absent femoral, popliteal or foot pulses. cold white legs, atrophic skin, punched out ulcers, postural/dependent colour change, cap refill >15s
tests
exclude DM, arteritis, FBC (anaemia, polycythaemia), U&E (renal disease), lipids, ECG- cardiac ischaemia, thrombophilia screen, serum homocysteine, ABPI
what is a normal ABPI
1-1.2
what is the ABPI in PAD
0.5-0.9
what is the ABPI in critical limb ischaemia
what is the first line imaging
colour duplex USS. if considering intervention- MRI/CT angiography
treatment
risk factor modification- clopidogrel, management claudication- supervised exercise programmes, vasoactive drugs. percutaneous transluminal angioplasty, surgical reconstruction, amputation
how is surgical reconstruction performed
with bypass graft. femoral-popliteal bypass, fem-fem crossover, aorto-bifem byupass graft, autologous vein graft superior to prosthetic graft
how soon is it needed for revascularisation of acute limb ischaemia
4-6h
what are the 6 Ps of ischaemia
Pale, Pulseless, Painful, Paraesthesia, Perishingly cold, Paralysed
what are the 6 Ps of ischaemia
Pale, Pulseless, Painful, Paraesthesia, Perishingly cold, Paralysed
what is the main symptom
intermittent claudication
symptoms
cramping pain- calf, thigh, buttock after walking given distance and relieved by rest, ulceration, gangrene, foot pain at rest eg burning pain at night relieved by hanging legs over side of bed
what is the classification
Fontaine- 1: asymptomatic. 2: intermittent claudication. 3: ischaemic rest pain. 4: ulceration/gangrene (critical ischaemia)
signs
absent femoral, popliteal or foot pulses. cold white legs, atrophic skin, punched out ulcers, postural/dependent colour change, cap refill >15s
tests
exclude DM, arteritis, FBC (anaemia, polycythaemia), U&E (renal disease), lipids, ECG- cardiac ischaemia, thrombophilia screen, serum homocysteine, ABPI
what is a normal ABPI
1-1.2
what is the ABPI in PAD
0.5-0.9
what is the ABPI in critical limb ischaemia
